Rotary Camp Staff Application — Heart of America Council

Please complete the form below to apply for a 2015 Rotary Camp Staff position. You will receive an email notification once your application has been submitted.

Applicants are not required to provide any information on this application that is prohibited by federal, state or local laws. All applicants will be given every consideration, but its receipt does not imply that the applicant will be interviewed or employed. The Heart of America Council does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in the provision of services or employment.

Personal Information

Please enter dates in MM/DD/YYYY format. If a question doesn't apply please enter NA. Many fields (questions) are required and you will not be allowed to go to submit the application if the field is left blank.

First Name

Middle Name

Last Name

Suffix

Please enter Sr. Jr. or any other suffix that may be applicable. If you do not have a suffix in your name please leave blank.

Date of Birth

BSA Member #

Payroll # (if known)

Address

City

State

Zip Code

Phone Number

Cellphone

Email Address

T-Shirt Size

Driver's License Number

DL Expiration Date

District

Unit Number

If training has not been completed please enter NA. Training information is required and you will not be allowed to go to the next page without entering a date or NA.

New for 2015 - All trainings must be taken every 2 years. If any of the training listed below is not up to date you must retake the training and provide proof.

Youth Protection

Hazardous Weather

Unlawful Harassment Training

CPR Certification Date (optional)

Camp Information

Position

Please check the position for which you are applying. (check all that apply)

Position
Director
Scoutmaster
Counselor
Instructor
CIT
Commissioner

Department Preference

I am interested in the following departments.

1^st Choice

2^nd Choice

3^rd Choice

Staff Experience

Please list your previous Camp Staff experience (up to three years). Include the Name of Camp, Position & Year on staff.

If this is your first year applying for Camp Staff, enter first year staff.

Previous Experience

Submit application information to another Scout Camp within the Heart of America Council.

If you would also like to apply for or be considered for a position at Theodore Naish Scout Camp or the H Roe Bartle Scout Camp please fill out the information below. (You do not have to fill out a separate application if you fill out this information)

Submit my information to Camp Naish
Yes
No

If applying for a Commissioner position please fill out the information below. I would like to be considered for the following at Camp Naish.

Naish Department

Submit my information to Bartle
Yes
No

If applying for a Commissioner position please fill out the information below. I would like to be considered for the following at Bartle Scout Camp

Bartle Position

Scouting History

Mic-O-Say Responsibility

Year Received

Tribal Name e.g. Wolf in the Night

Order of the Arrow

Year Received

Total Years in Scouting

Last Three Leadership Positions Held

(e.g. Scoutmaster, Patrol Leader, etc.)

Please list current position first.

Training

Certificates of Advanced Training (check all that apply)
Amateur Radio License
BSA Lifeguard
Climbing Level 1
Climbing Level 2
COPE Level 1
COPE Level 2
CPR
Den Chief
National Camp School
NRA Basic Instructor
NYLT
Range Safety Officer
USA Archery Level 1
Wilderness First Aide
Wood Badge

Educational Background

Please include the name of school and year graduated. If does not apply enter NA.

High School

College

Technical School

Graduate School

Honors & Achievements (other than Scouting)

Employment History

Name of Employer

Job Title

Start Date

End Date (leave blank if still employed)

Address

City, State & Zipcode

Supervisor's Name

Employer Phone Number

May we contact your current Employer?
Yes
No

Reason for leaving (leave blank if still employed)

Additional Information

Have you ever been discharged or been asked to resign from any job?
Yes
No

If yes, please explain why?

Have you ever used illegal drugs?
Yes
No

Have you ever been charged with child neglect or abuse?
Yes
No

Have you ever been convicted of a criminal offense?
Yes
No

If yes, please give an explanation of the circumstances.

Has your driver's license ever been suspended or revoked?
Yes
No
Don't have a license

If yes, please give an explanation of the circumstances.

Do you use Tobacco Products?
Yes
No

If yes, do you agree to abide by the Camp Tobacco use policy?
Yes
No

Council Tobacco Use Policy: Smoking or chewing tobacco is NOT allowed for any employee under 21 years of age. Smoking or chewing tobacco by any employee under 21 will result in a notation in an employee's personnel file and could result in termination. Use of tobacco in program areas is prohibited. (Adult staff members agree to smoke or chew only in designated areas and not in front of those under 21 years of age, and not in any buildings. Camp Council rings and their surrounding areas and trails are also considered to be program areas.)

References

Please list three individuals (not relatives) who have knowledge of your character, experience and ability. By listing these references, you are giving us your permission to contact these people to speak on your behalf. If you as the applicant are under 18 years of age, one listed reference must be your Unit Leader. References must be listed before your application will be considered for evaluation.

Please include the reference name, relationship, email address and telephone number for each reference listed.

Reference 1

Reference 2

Reference 3

Why do you wish to be a member of the Rotary Camp Staff?

Additional Documentation

Before you can be offered a position on Camp Staff you must fill out, sign and return to the Council office an additional document (see instructions below). You can email the document to cheri.williams@scouting.org, fax to 816-942-8086 or mail in to Attn: Camping Office 10210 Holmes Kansas City, MO 64131. A link to these forms will be included in your confirmation email that is sent once your application has been received. You can also find the forms at hoac-bsa.org under Camping Resources.

If you are 18 or over on June 1, 2015, please fill out the Disclosure to Employment Authorization Form.
If you are under 18 on or before June 1, 2015, please fill out the Heart of America Camp Staff Employment Disclosure Form.

I understand I need to submit the Disclosure form as described above.

Make sure to enter the verification code in the "type in the text" box below before you hit submit. If you remain on the application page after you hit submit then your application has not been submitted. Double check for any error messages and that you've entered a correct verification code. Once the application is submitted you will be directed to a thank you page.